The applicant's long-term career objective is to decrease racial disparities in liver diseases in the United States by conducting well-designed patient-oriented research and by increasing the number of highly trained research scientists engaged in patient-oriented research in digestive diseases. Chronic hepatitis C virus (HCV) infection is the most common etiology for liver cirrhosis and a major cause for primary hepatocellular carcinoma (HCC) in the US. Several well-designed population studies have found a greater HCV prevalence and both a higher HCC incidence and mortality from primary hepatocellular carcinoma in Black Americans compared to White Americans. Ironically, Blacks have a much lower rate of HCV clearance during peginterferon plus ribavirin treatment. A better understanding of the causes for health disparities based on race is a necessary to develop comprehensive strategies to improve the health of racial minorities as well as the general US populace. Dr. Howell is an established investigator with an excellent track in patient-oriented research on racial disparities. His immediate career objectives are: 1) to develop a new patient-oriented research studies investigating the basis for racial disparities in liver disease; 2) to provide high-quality mentorship for the increasing numbers of trainees interested in patient-oriented liver research at the University of Maryland, including Gastrointestinal and Infectious Diseases research training grants; and 3) to strengthen his background for future patient-oriented research projects and mentoring by completing didactic coursework in clinical investigation. The Midcareer Investigator Award in Patient-Oriented Research (K24) award will enhance the applicant's career development and future success in patient-oriented research by allowing him to decrease his patient care, teaching, and institutional service obligations and to spend more time pursuing these important goals and objectives.